1

Interprofessional Relationship

of Medicine and Management

is the Foundation of Success

of Global Healthcare Systems

By Dr. Atefeh Samadi-niya, MD, DHA (PhD), CCRP (Canada)

October 6, 2015, 1:30-3:00 pm,

Free Paper Presenter under category of

Healthcare Management: An HR Focus

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Welcome to Healthcare Leaders at IHF39

Microsoft on-line pictures, exact source: unknown

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Honored to be an ACHE member, a FACHE

Candidate, and a recipient of ACHE Service

Award in 2015

Courtesy of Dr. Atefeh Samadi-niya, Presenting at ACHE

Congress, March 2015

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Presenter: Dr. Atefeh Samadi-niya

1. Doctor of Medicine ( MD, physician, or Medical Doctor)

2. Doctor of Health Administration / Medical Management (DHA /

PhD)

3. Certified Clinical Research Professional / Educator (CCRP)

4. Certified Clinical Research Associate (CRA)

5. Designed and led CANSIRPH (2007-2014)

6. Member/mentor/executive/officer of professional organizations

7. Lives in Greater Toronto Area (Mississauga), Ontario, Canada.

8. Works on-line globally:-)

9. Website is being designed.

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Atefeh Samadi-niya Biography With 20 years of experience, the wide range of professional activities of Dr. Atefeh Samadi-niya connects different

sectors of healthcare system of Canada; from acute care to long-term care, prevention to treatment, patient care

to population health, and Medicine to management / leadership. Dr. Samadi-niya has expertise in health system

research, as well as in strategic planning and system performance measurement. She has extensive professional

experience in the health sector in Canada, the U.S., and globally. More than 12 years of web-based experience

have shaped a 21st century leader who is prepared to peruse newest inventions and implement the latest

innovations in research and analysis of healthcare information leading to a better healthcare for Canadians.

Dr. Samadi-niya’s previous experience includes designing and completing the Canadian National Study of

Interprofessional Relationships between Physicians and Hospital Administrators from 2008-2013 (CANSIRPH),

presenting at different conferences and congresses at local, national, and international levels, publishing articles

focusing on Quality Improvement (QI) of patient care by Quality Investment (QI) in Physician-Hospital

Relationships (PHR) across Canada, and mentoring younger professionals at both CCHL and ACHE. She has

presented at different conferences and congresses and published a few articles and an open access Doctoral

Dissertation. Dr. Samadi-niya has led many professional groups across the globe from 2006-2011.

She is the Communication Officer of the GTA Chapter of Canadian College of Health Leaders (CCHL), Board of

Officers’ member of the GTA chapter of CCHL. She served as the executive member and Board member of the

GTA Chapter of CCHL from 2013-2015 and acted as a member of the Board of Directors as well as the

Communication Committee’s Chair of the American College of Healthcare Executives (ACHE) from 2012-2014.

She has been invited to join the Editorial Review Board / Peer Review of a few publications.

Dr. Samadiniya holds a Doctorate of Health Administration or PhD in business of healthcare from the U.S., a Doctorate

of Medicine and the Licentiate of Medical Council of Canada as well as a post-doctorate certificate in Canada, and

an international certificate as a Research Professional / Educator. She has had executive leadership training and

will receive her Fellowship status by ACHE (FACHE) and Certified Healthcare Executive (CHE) by CCHL in year

2016.

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Atefeh Samadi-niya, MD, DHA (PhD), CCRP

• Atefeh.Samadiniya@gmail.com

• www.twitter.com/Dr_Niya (tweets & replies)

• https://ca.linkedin.com/in/drsamadiniya

• Tel: 416-402-3906 (accepts text as well)

• Skype: Atefeh.Samadiniya

• Updated Website addresses will be posted on

LinkedIn page (Accepts LinkedIn invitations)

Personal Contact Information C

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Agenda

1. Acknowledgment, Introduction, and Background

2. Summary of a national research study (CANSIRPH)

3. Interprofessional Relationships between Physicians and Healthcare Administrators: IRPH

4. Differences in perspective of MD-leaders and Non-MD leaders about IRPH

5. Factors that affect IRPH and to what degree

6. Reasons for having less than optimal IRPH

7. Benefits of improving IRPH

8. Solutions provided by leaders to improve IRPH

9. Questions and Answers

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means — electronic, mechanical, photocopying, recording, or otherwise — without the permission of Dr. Atefeh Samadi-niya. For further information about Canadian National Study of Interprofessional Relationships between Physicians and hospital administrators, please see list of references of CANSIRPH at the end of this presentation or contact Atefeh.Samadiniya@gmail.com

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Let’s thank all people who support us

Each of us has had at least 9 supporters in life

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Acknowledgement of Individuals

•My family, friends, colleagues, and acquaintances

•Dr. George J. Graham, Ph.D. (University of Phoenix,

AZ, U.S.A.): Dissertation Chair

•Mr. Ken Tremblay, CHE, FACHE (ACHE mentorship

program)

•Dr. Thomas G. Rundall, Ph.D. (University of Berkeley,

CA, U.S.A. ): permission for questionnaire

•Healthcare Leaders who participated in CANSIRPH

•Patients who believe in us to try our best to

save them

Samadi-niya, 2013, dedication

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Acknowledgement of Organizations

Samadi-niya , 2013, 2014b

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Leaders‘ Best Friend

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Organisation for Economic Co-

operation and Development (OECD)

OECD, About. Available at: http://www.oecd.org/about/whatwedoandhow/

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What Does OECD Do?

“OECD's work is based on continued monitoring

of events in member countries as well as outside

OECD area, and includes regular projections of

short and medium-term economic

developments. The OECD Secretariat collects

and analyses data, after which committees

discuss policy regarding this information, the

Council makes decisions, and then governments

implement recommendations” (OECD, About).

(OECD, About). Available at: http://www.oecd.org/about/whatwedoandhow/

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OECD Member Countries 2015

1. AUSTRALIA

2. AUSTRIA

3. BELGIUM

4. CANADA

5. CHILE

6. CZECH REPUBLIC

7. DENMARK

8. ESTONIA

9. FINLAND

10. FRANCE

11. GERMANY

12. GREECE

13. HUNGARY

14. ICELAND

15. IRELAND

16. ISRAEL

17. ITALY

18. JAPAN

19. KOREA

20. LUXEMBOURG

21. MEXICO

22. NETHERLANDS

23. NEW ZEALAND

24. NORWAY

25. POLAND

26. PORTUGAL

27. SLOVAK REPUBLIC

28. SLOVENIA

29. SPAIN

30. SWEDEN

31. SWITZERLAND

32. TURKEY

33. UNITED KINGDOM

34. UNITED STATES

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Health Spending In Canada

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CIHI, 2014, available at: https://www.cihi.ca/en/nhex_2014_report_en.pdf

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70/30 is the percentages of Public sector/Private sector

involvement in financing health care of Canada

86% or more of funding for hospitals has been provided

by the public sector since 1994; the national figure

92% in 2005

Financing Health Care in Canada

(CIHI, 2005, p.41).

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• Canadian Institute of Health Information

Almost all hospitals in Canada are not-for-profit

owned by Government, Regional Health authorities

and religious groups.

Public sector paid 93% of hospital costs in 2004.

Financing Hospital Services in

Canada

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(CIHI, 2005, p47)

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Decrease in hospital share of financing: 30%

of total in 2004 comparing to 45% in 1989.

Hospitals spent 39 billions of dollars in

Canada, which is about 30% of total

healthcare spending.

Financing Hospital Services in

Canada, cont.

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(CIHI, 2005, p.41-42)

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Canada Health Act ensures that all necessary medical services are paid by Public health

insurance plans.

98% of Physician services are paid by public insurance in Canada

59,000 physicians in Canada at the end of 2003

Pay-for-performance, fee schedule negotiated by medical professional bodies

of each province, other method of physicians payments are salaries,

benefits, and capitation.

Financing Physician Services In

Canada

CIHI, 2005, p51-52

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Hospitals and Physicians have different payment schedules and services, although both are funded mostly

from the public sources in Canada

Physicians are not employees of Hospitals and usually are considered contractors.

As contractors, physicians want more authority in patient care and less pressure from administration.

Physicians also want hospitals to listen to include them in decision-making process.

Hospitals and Physicians in Canada

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Physician-Hospital Relations in OECD

Countries Physician-hospital relations has been a topic of research in

such OECD countries as the United State, the United

Kingdom, Norway, Germany, and Australia.

Neogy and Kirkpatrick (2009) compared physician-hospital

relations in European countries. Health reforms started in

most European countries during the 1980s, but France held

back until recently. Denmark is more advanced in terms of

involving doctors in managerial roles. France and the

United Kingdom are less advanced than Denmark and

Germany while the Netherlands and Italy show a mixed

picture in which some hospitals have medical personnel

involved with management and some do not (Samadi-niya,

2013, p2).

(Ham,2008;Kirkpatrick, Shelly, Dent, & Neogy, 2008; Klopper-kes et al., 2009; Neogy & Kirkpatrick,

2009; Rundall, Davies, Hodges, & Diamond, 2004; Vera & Hucke, 2009)

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Research about Physician-Hospital Relations (PHR) in the U.S., the U.K, and other OECD countries but not in Canada.

General Problem was that quality of Interprofessional Relations affects quality of patient care.

Specific problem was that quality of IRPH in Canada was unclear.

What about Canada?

Davies et al., 2003; Rundall et al., 2004; Shortell, 2001; Samadi-niya, 2013

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http://www.oecd.org/els/health-systems/Briefing-Note-CANADA-2014.pdf

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Professional relationships

between Physicians and

Managers have been topic

of many research studies

since 1980s

Ache, 2007; Byrne, 2007; Curtis, 2001; Cohn and Allyn, 2005; Hariri, Presipino, and Rubash, 2007; Holm, 2000 ; Lemieux-Charles, 1989; Minich, 1999; Snail, 2000; Shortell, 2001; Teresa, 2004; Vavalva,1995; Weber, 2006; Weiss, 2004; Waldman, Smith, Hood, and Pappelbaum, 2006; Ziegenfuss and Sassani, 2007; and more than 300 references mentioned in Samadi-niya, 2013.

Medicine and Management Relationships

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Patient care is only as strong

as interprofessional

relationships between

doctors and managers of a

healthcare system.

Patient Care Strength

Baker et al., 2010; OHA, 2004

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If neglected, the interprofessional

relationships of physicians and

healthcare administrators can

adversely affect the quality of patient

care and deplete the financial

resources of healthcare systems.

Doctor-Managers Relations and Quality

of Patient Care

OHA, 2004

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Samadi-niya , 2013, 2014 a, 2014c, 2015 b

Canadian National Study of Interprofessional

Relationships between Physicians and Hospital

Administrators (CANSIRPH) was the first detailed

research study focusing on the perception of

healthcare leaders about the quality of

Physician-Hospital Relations (PHR) across all

provinces/territories in Canada. CANSIRPH

(pronounced as CAN SURF) started

with an Idea: What If...?

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What if…

Quality Improvement (QI) Of interprofessional relationships between doctors and managers means

Quality Improvement (QI) of Patient care and

Quality Investment (QI) On Healthcare System with high return on investment because of error reduction and patient safety.

Pictures are courtesy of Dr. Atefeh Samadi-niya

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Reason for Designing CANSIRPH

1. National Physician Survey (NPS) of 2004 had

one statement about satisfaction with PHR

– More than 20% of Canadian doctors not

satisfied with PHR.

– Only 15% of Canadian doctors completely

satisfied with PHR

2. Doctor’s satisfaction with PHR meant 1.7 times

more satisfaction with doctor’s professional life.

CIHI, 2006; Comeau, 2007

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• An Idea started as a Dissertation Research Question and it turned

into a Canadian National Research Study

• National study in Canada, all acute care hospitals

• 4000 mid to senior (MD & non-MD) Hospital Leaders

• More than 700 hospital/healthcare systems across Canada

• SCOTT’s Directories, CCHL, ACHE/Canada, CSPE, Snowball

recruiting Method by referrals

• On-line survey, 71 questions, mostly Likert-type but some open

ended. Canadian version of Rundall et al. 2004, used with

permission.

• Generalizable results for Canada and Ontario

Summary of CANSIRPH

(Open Published Dissertation)

Samadi-niya, 2013

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In 2004, 7.5% of patients or about 1 of every 12 patients admitted to the Canadian acute care hospitals experienced AEs of which 36% were preventable (Baker, 2004); No change to the rate of Medical

Errors in 2014 after 10 years from original study.

Medical Errors

Red Flag: Could Physicians and Managers lead to these

errors by their lack of cooperation? A positive healthy

relationship between hospitals and physicians with “focus

on delivering quality patient care and ensuring economic

validity for both parties” should be the main focus of both

parties (Hariri, et al., 2007, p. 78)

Baker, 2004, Hariri, et al, 2007

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Physicians: There are Many Obstacles

to Patients Safety

Physicians say that there are many

obstacles to patients safety

Therefore, “successful collaboration

is result of discussions about issues

that were critical to physicians and

Hospitals.”

(Curtis, 2001, para 16. Steiger, 2007)

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• Medical errors increase the length of stay for patients and the

cost spent on patients who have preventable medical errors.

• The estimated cost of extra days spent at hospitals due to

preventable medical errors was about $125 million in Ontario

alone.

• The estimated cost related to the medical errors was about

14% of the total healthcare cost in 2009.

• The percentage for physicians’ remuneration and hospital

services in Ontario in 2009 was only about 36% of the total

healthcare expenditure.

Cost of Medical Errors

OACCAC et al., 2010

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• Interprofessional Relationships between Physicians and Healthcare Administrators (IRPH)

• Equal terms to Doctor-Manager Relations, Physician-Hospital Relations, Physician-Healthcare Relations, Physician-Executive Relations, Doctor-Administrator Relations, Physicians and Healthcare System Relations, Physician Engagement in healthcare leadership…

Interprofessional Relationships of

Medicine and Management

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Samadi-niya, 2013, 2014a

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Significance of

CANSIRPH

Healthcare planners and

healthcare leaders

Universities programs in Medicine &

Management, administration

Hospital administrator, executives &

Board

Physicians, Physician leaders,

physician executives Patients,

Nurses, other allied

healthcare professionals

Professional bodies for healthcare executives

Government, policy makers

OECD member countries

Other countries

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Patient as Center of Care Trust Us To

Collaborate as Leaders

Courtesy of Dr. Atefeh Samadi-niya, July 2015

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Most Important Stakeholder of Physician-Hospital

Relationships: Our Family and friends

Courtesy of Dr. Atefeh Samadi-niya, December 2014, my mother

and I

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All Leaders Agreed: IRPH is Key

Samadi-niya , 2013

0% 10% 20% 30% 40% 50% 60%

Extremely Agree

Agree

Neutral

Disagree

Extremely disagree

Extremely Agree Agree Neutral Disagree Extremely disagree

Series1 57% 37% 6% 0% 0%

CANSIRPH Participants Consider Interprofessional

Relationships Between Physicians and Hospital Administrators

as the Key to the Success of Healthcare System

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Physicians as Partners

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Meaningful Differences In Level Of Leaders’

Satisfaction Toward IRPH:

CANSIRPH Results

• Non-physician

leaders

• Physician Leaders

• Senior Level

• Mid-level

• Larger proportion of

physician-leaders

Do NOT see IRPH

as collaborative

• Larger proportion of

non-physician

leaders see IRPH as

collaborative!

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Mid-Level Physician Leaders

Senior Level Physician Leaders

Mid-Level Non-Physician leaders

Senior Level Non-physician Leaders

Differences in Level of Satisfaction of

Leaders toward IRPH: 4 Groups

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Samadi-niya, 2014; available at: https://drive.google.com/file/d/0B2yM6NbV3OhRWm9sSXAxSEhLWEk/view?usp=sharing

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Effect of Single Factors on Level of

Satisfaction of Leaders Toward IRPH

0% 20% 40% 60%

Teamwork and Communication

Role Cabability including …

Relative Power

Adequacy of Resources

Financial Contracts

Financial drivers vs. Clinical …

Technology including IT or HIT

56%

54%

50%

32%

29%

24%

22%

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Teamwork and communication and role

capability including leadership had

significant meaningful correlation with

Level of satisfaction of Leaders toward

IRPH when all seven factors considered

simultaneously (Bonferroni test).

Influence of Seven Factors

Simultaneously

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Samadi-niya, 2015 available at: http://oaccac.com/Who/Conference/Documents/2015%20Posters/Factorsthatinfluence.pdf

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Perspectives of CANSIRPH

Participants

1. Benefits of Improving IRPH

2. Barriers of Improving IRPH

4. Surprises and Recommendations

3. Suggested Methods of

Improving IRPH Copyri

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Benefits of Improving IRPH

Improving

1. Patient safety

2. Quality of patient care

3. Patients and their families’ experience

4. Mutual understanding

5. Communication

6. Collaboration

7. Leadership

Improving

8. Decision-making

9. Use of resources

10. Physician engagement

11. Teamwork

12. Open dialogue and Crucial conversations

13. Budget management

14. Management

Samadi-niya, 2013, 2015b, available at:www.ncbi.nlm.nih.gov/pubmed/25850163

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Barriers of Improving IRPH

The barrier according to CANSIRPH Percentage

External economic and regulatory forces 27%

Internal disagreements among board, management,

and medical staff 12%

Time demands hospitals place on physicians and the

loss of income that may result 28%

Financial reasons 8%

Other Barriers 25%

Total 100%

Samadi-niya, 2013

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Barriers of Improving IRPH Cont.

Some examples of the “ Other” category written by participants

of CANSIRPH

1. “Administrators want to meet from 9 am to5 pm when all the

clinical work has to be done. Docs want meetings at 7am or

6 pm after the work is done.

2. “There is a notion that patient care is paramount yet budgets

dictate how patient care is managed.

3. “Viewing physicians as cost-generators and resource

consumers rather than revenue maker.

4. Not paying physicians for administrative/managerial tasks.

Samadi-niya, 2013

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Leading Patients to their homes Courtesy of Dr. Atefeh Samadi-niya, spring 2014

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Suggested Methods of Improving IRPH

There are 30 suggestions; A few listed here:

1. Dyad Leadership: MD-leaders and Non-MD leaders

2. Communication, communication, and communication.

3. Presence of executive leaders in front lines

4. Administrative duties are not hobby of physicians, please pay them

for leadership roles.

5. Formal administrative and management training for physician

leaders. Not choosing physician leaders due to clinical work.

Physician Leadership is not performing well as the written tests of

medical school.

6. Using 360 performance evaluation of all management levels

Samadi-niya, 2013, p.262, 2015c, available at: www.ncbi.nlm.nih.gov/pubmed/25850163

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Surprises and Recommendations

1. Interprofessionalism is different from interdisciplinary

relations

2. Physicians showed so much interest in CANSIRPH

3. The most influencing factor is neither MONEY nor

RESOURCES; is COMMUNICATION and TEAMWORK!!!!!

4. DYAD leadership of physician-leaders and non-physician

leaders has been used and it is found useful and effective.

5. IRPH actually means involving in decision-making equally.

Samadi-niya, 2013, 2015c

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1. CANSIRPH results helped understand views of MD leaders and Non-MD

leaders across Canadian acute care hospitals toward IRPH and assessed

the level of influence of selected factors on IRPH.

2. Interprofessional relationships between Medicine and Management

is the foundation of the success of global healthcare systems

because the NEWS in one OECD country, including CANSIRPH Results,

disseminate to other member countries, make a difference, and become

recommendations for governments to improve economy and health.

3. Teamwork and communication as well as role capability including

leadership are the most important influencing factors on opinions of

leaders about the quality of IRPH.

Conclusion

Samadi-niya, 2013, 2014c, 2015b

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Look for possibilities where you do not expect them

Courtesy of Dr. Atefeh Samadi-niya, July 2015, A flower showed up from a plant that I thought was a weed. I said to myself, let’s give it some time

and see what this plant is after all:-)

54 54

Reference Related to CANSIRPH Samadi-niya, A. (2015g, Oct 6). Interprofessional Relationship of Medicine and

Management is the Foundation of Success of Global Healthcare Systems. Paper Presented at the World Hospital Congress IHF39 by American College of Healthcare Executives, American Hospital Association, and International Hospital Federation: Chicago, U.S.A. Program Brochure available at: http://www.worldhospitalcongress.org/documents/Programme/2015_IHF_Congress_Brochure.pdf (suggested for referring to this presentation, the link might change after posting the presentation on the IHF39 site)

Samadi-niya, A. (2015f, October 1). How strengthening the relationships between Medicine and

Management improves care, the Hospitals and Health Networks (H&HN Daily); The Official publication of the American Hospital Association. Available at: http://www.hhnmag.com/Daily/2015/September/patients-benefit-by-physician-nonphysician-leaders-interprofessional-blog?utm_source=daily&utm_medium=email&utm_campaign=HHN&eid=253083209&bid=1191388

Samadi-niya, A. (2015e, May 29). Effects of Interprofessional Doctor-Manager

Relationships on Patient Care Quality. Paper presented as oral presentation at the OACCAC Annual Conference 2015. Available at: http://oaccac.com/Who/Conference/Documents/2015%20Presentations/FA07-EffectsOf.pdf

Samadi-niya A. (2015d, May 27-29). Factors that influence Relationships of Medicine and Management as well as Leadership and Governance of Healthcare systems in Canada. Paper presented as a poster at the OACCAC annual Conference, Available at: http://oaccac.com/Who/Conference/Documents/2015%20Posters/Factorsthatinfluence.pdf

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References Related to CANSIRPH Cont.

Samadi-niya, A. (2015c, April 23). Suggested Methods to Improve Physician-Hospital Relationships in Canada [YouTube Video]. Available at the official YouTube channel of the Canadian College of Health Leaders, HealthLeadersCanada www.youtube.com/watch?v=PqVVW-v1qoU and its Facebook page https://www.facebook.com/CCHL.National/posts/938602106184889

Samadi-niya, A. (2015c, April 7). Suggested Methods to Improve Physician-Hospital Relationships in Canada [invited paper], Official journal of the Canadian College of Health Leaders: Journal of Healthcare Management Forum. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25850163

Samadi-niya, A. (2015b, Spring). Part 2: The perception of Canadian healthcare leaders toward physician-hospital relations . The official Magazine of the Canadian Society of Physician Executives: Canadian Physician Leadership Journal. 4; 35-39. Available at: www.cspexecs.com/assets/cspejournalspring.pdf

Samadi-niya, A. (2015a, March 18). The Results of A National Research Study: Interprofessional Relationships Between Physician Leaders and Non-physician leaders Is The Key To The Success of Healthcare System. Paper presented at the Forum on Advancement of Healthcare Management as part of the Congress on Healthcare Leadership by the American College of Healthcare Executives, Chicago, U.S.A. Available at: http://www.nxtbook.com/nxtbooks/ache/2015congress/#/38 or download the session handout at session 90, www.ache.org/congress/download multimedia session handouts)

Samadi-niya, A. (2014 d, Fall). Part 1: The importance of physician-hospital relations in Canadian healthcare system. The official Magazine of the Canadian Society of Physician Executives: Canadian Physician Leadership Journal . Available at: www.cspexecs.com/assets/cspejournalfall.pdf

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ed.

56 56

Samadi-niya, A. (2014c, July). Interprofessional relationships between physicians and hospital administrators across Canada: A quantitative multivariate correlational study [Abstract, Dedication, Acknowledgement]. Dissertation Abstract Journal. University of Phoenix, School of Advanced Studies. Phoenix: U.S.A. Available at: https://s3.amazonaws.com/webmkt/alumni/Dissertation+Abstract+Journal+-+July+2014.pdf

Samadi-niya , A. (2014b, June). Differences that exist in perceptions of physician leaders and hospital administrators toward physician–hospital relations across Canadian hospitals. Poster presented at the 2014 National Health Leadership Conference: Raising the bar: a critical time for bold leadership, Banff, Alberta, Canada. Available at: http://www.nhlc-cnls.ca/assets/Samadi%20Poster%20Abstract.pdf and the actual poster available at: https://drive.google.com/file/d/0B2yM6NbV3OhRWm9sSXAxSEhLWEk/view?usp=sharing

Samadi-niya , A. (2014a, June 3). Canadian national view on physician–hospital relations. Presented at the 2014 National Health Leadership Conference: Raising the bar: a critical time for bold leadership, Banff, Alberta, Canada, 2–3 June 2014. Ottawa: Canadian College of Health Leaders and HealthCareCAN. Available at: http://www.nhlc-cnls.ca/assets/25_Canadian%20national%20view_Samadi-niya.pdf

Samadi-niya, A. (2013). Interprofessional relationships between physicians and hospital administrators across canada: A quantitative multivariate correlational study (Order No. 3583264, University of Phoenix). Open ProQuest Dissertations & Theses Full Text. (1552485304). Available at:

http://pqdtopen.proquest.com/doc/1552485304.html?FMT=ABS&pubnum=3583264

or http://gradworks.umi.com/35/83/3583264.html

Leaders Making a Difference. (2012, June 5). American College of Healthcare Executives, Canadian Chapter Newsletter. Available at: http://newsmanager.commpartners.com/achecca/issues/2012-06-05/11.html

References Related to CANSIRPH Cont.

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ACHE: American College of Healthcare Executives. (2007). Hospital Survey:Top issues confronting

Hospitals, Available at: http://www.ache.org/PUBS/research/ceoissues.cfm

Baker, R. G., Norton, P. G., Flintoft, V., Blais, R., Brown, A., Cox, J., . . . Tamblyn, R. (2004). The

Canadian adverse event study: The incidence of adverse events among hospital patients in

Canada. Canadian Medical Association Journal, 170(11), 1678-1686.

Byrne, F. (2007, July). Aligning Physician-Hospital Relations: An integrated Approach. Healthcare

Executive, 22(4), 8-12.

Canadian Institute of Health Information (CIHI). (2005). Exploring the 70/30 split: How Canada’s

healthcare system is financed. Ottawa, ON: Author. Retrieved from

http://secure.cihi.ca/cihiweb/products/FundRep_FR.pdf

CIHI (2006, November). Understanding physician satisfaction at work: Results from the 2004 National

Physician Survey. Ottawa, ON: Author. Available securely at:

http://secure.cihi.ca/cihiweb/en/downloads/ hhr_physicians_analysis_in_brief_nov2006_e.pdf

CIHI (2014, October). National health expenditure trends, 1975-2014. Available at: available at:

https://www.cihi.ca/en/nhex_2014_report_en.pdf

Comeau, M. (2007, January 30). Professional satisfaction among Canadian physicians: A

retrospective look at survey results (professional satisfaction). Available at:

http://www.nationalphysiciansurvey.ca/nps/reports/PDFe/Professional_Satisfaction_26-01-07.pdf

Cohn, K., & Allyn, T. (2005, October). Making hospital-physician collaboration work. hfm (Healthcare

Financial Management), 59(10), 102-108.

Curtis, R. (2001, Spring). Successful Collaboration Between Hospitals and Physicians: Process or

Structure? Hospital Topics, 79(2), 7-13.

Other References

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ights

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Other References cont. Comeau, M. (2007, January 30). Professional satisfaction among Canadian physicians: A

retrospective look at survey results (professional satisfaction). Available at: http://www.nationalphysiciansurvey.ca/nps/reports/PDFe/Professional_Satisfaction_26-01-07.pdf

Cohn, K., & Allyn, T. (2005, October). Making hospital-physician collaboration work. hfm (Healthcare Financial Management), 59(10), 102-108.

Curtis, R. (2001, Spring). Successful Collaboration Between Hospitals and Physicians: Process or Structure? Hospital Topics, 79(2), 7-13.

Davies, H. T., Hodges, C. L., Rundall, T. G., & Kaiser, H. J. (2003). Consensus and contention: Doctors’ and managers’ perceptions of the doctor-manager relationship. British Journal of Healthcare Management, 9(6), 170-176.

Ham, C. (2008). Doctors in leadership: Learning from international experience. International Journal of Clinical Leadership, 16(1), 11-16.

Hariri, S., Prestipino, A., & Rubash, H. (2007, April). The hospital-physician relationship: past, present, and future. Clinical Orthopaedics And Related Research, 457, 78-86.

Hospital Physician Issues Working Group. Hospital–physician relationships: where do we go from here? (2004). Toronto: Ontario Hospital Association. Available: www.oha.com/CurrentIssues/keyinitiatives/eHealth/Documents/Hospital%20Physician%20Relationships%20-%202004.pdf

Ideas and Opportunities for Bending the Healthcare Cost Curve: Advice for the Government of Ontario. Toronto, Canada: Ontario Association of Community Care Access Centers, Ontario Hospital Association, Ontario Federation of Community Mental Health and Addiction Programs; 2010. Available at: https://www.oha.com/KnowledgeCentre/Library/Documents/Bending%20the%20Health%20Care%20Cost%20Curve%20%28Final%20Report%20-%20April%2013%202010%29.pdf

Copyri

ghte

d b

y A

tefe

h S

am

adi-

niy

a

© 2

015 ,

All R

ights

Reserv

ed.

59 59

Kirkpatrick, I., Shelly, M., Dent, M., & Neogy, I. (2008). Towards a productive relationship between

medicine and management: Reporting from a national inquiry. International Journal of Clinical

Leadership, 16, 27-35.

Klopper-kes, A. H. J., Meerdink, N., Van Harten, W. H., & Wilderom, C. P. M. (2009). Stereotypical

images between physicians and managers in hospitals. Journal of Health, Organization and

Management, 23(2), 216-224. doi:10.1108/ 14777260910960948

Lemieux-Charles, L. (1989). Hospital-physician integration the influence of individual and organization

factors. Ph.D. dissertation, University of Toronto, Canada. Retrieved July 25, 2007, from ProQuest

Digital Dissertations database. (Publication No. AAT NL54630).

Minich, P.J. (1999). Physician leadership: A focused solution for a sick healthcare system. Ph.D.

dissertation, Vanderbilt University, United States -- Tennessee. Retrieved July 1, 2007, from

ProQuest Digital Dissertations database (Publication No. AAT 9958457).

Neogy, I., & Kirkpatrick, I. (2009, November). Medicine in management: Lessons across Europe.

Leeds, UK: Center for Innovation in Health Management, University of Leeds. Retrieved from

http://www.cihm.leeds.ac.uk/new/ wp-content/uploads/2010/01/6382_MM_brochure_print.pdf

Rundall, T. G., Davis, H. T., Hodges, C. L., & Diamond, M. (2004). Doctor-manager relationships in the

United States and the United Kingdom. Journal of Healthcare Management, 49(4), 251-268.

Other References Cont. C

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tefe

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ights

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60 60

Other References Cont. Snail, T.S. (2000). The effects of hospital contracting for physician services on hospital

performance. Ph.D. dissertation, University of California, Berkeley, United States -- California. Retrieved July 29, 2007, from ProQuest Digital Dissertations database. (Publication No. AAT 9979813).

Steiger, B, (2007, May/June). Doctors say many obstacles block paths to patient safety: result of survey by American College of Physician Executives. Physician Executive, 33 (3), 6-14.

Shortell SM. (1991).Effective hospital-physician relationships. Ann Arbor (MI): Health Administration Press;

Teresa M. (2004). Personal to political: The changing relationship of the OHA and the state in Ontario. Ph.D. dissertation, University of Toronto (Canada), Canada. Retrieved July 25, 2007, from ProQuest Digital Dissertations database. (Publication No. AAT NQ94486).

Vavala, D. (1995, January). Lonely at the top and loving it: Physicians as CEOs. Physician Executive, 21(1), 30.

Vera, A., & Hucke, D. (2009). Managerial orientation and career success of physicians in hospitals. Journal of Health Organization and Management, 23(1), 70-84.

Waldman, J.D., Smith, H.L. & Hood, J.N. (2006). Healthcare CEOs and physicians: reaching common ground. Journal of Healthcare Management, 51(3), 171-83, discussion 183-4.

Weber, O. (2006). Friction Points!. Physician Executive, 32(4), 6-11.

Ziegenfuss, F. I., & Sassani, F. I. (2008). Health administration education for physicians: why?. Am J Med Qual., 23(1), 5-6.

Please see references of Samadi-niya, 2013, 2014, 2015 for more resources.

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ights

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Disclosure of Relevant Financial Relationships

By Faculty and Planners of Continuing Education Activities

It is the policy of the IHF/AHA/ACHE to ensure balance, independence, objectivity and scientific rigor in all of its’

directly sponsored or jointly sponsored Continuing Education (CE) activities. The intention of this policy is to identify

potential conflicts of interest, facilitate resolution according to protocols, and ensure that disclosure is provided to

participants prior to the beginning of the activity so that learners may formulate their own judgments as to the objectivity

of the activity.

All individuals in a position to influence and/or control the content of IHF/AHA/ACHE directly and jointly sponsored CE

activities must disclose to IHF/AHA/ACHE and subsequently to learners that the individual either has no relevant

financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or

provider(s) of commercial services discussed in the CE activities.

Conflict of Interest: Circumstances create a conflict of interest when an individual has received financial benefits in any

amount from a commercial interest within the past 12 months and that individual is in a position to affect the content of

CE regarding products or services of commercial interest.

Commercial Interest: A commercial interest is considered any entity producing, marketing, re-selling, or distributing

goods or services.

Financial Relationships: A financial interest is established by payments for various activities to the individual, the

individual’s spouse or partner by proprietary companies related to the content of a CE program. Examples of payments

that constitute financial interests include grants or research support, employment, consultation, speaking or teaching

activities, or royalties for companies. Financial interest also includes owning stock or options in any amount in these types

of companies.

Name:

Event Title: IHF 39th World Hospital Congress

Program Title:

Relationship: Free Paper Presenter

Do you or any immediate family member have a financial relationship or interest (currently or within the past 12 months)

with a proprietary entity? Yes No

If Yes, please identify the company and the nature of the financial relationships and compensation below.

Self

and/or

Immediate Family

Member

Commercial

Interest

Type of

Relationship

Nature of

Compensation

Relevant to

Presentation

Content

Yes/No

Example: Self Company M Board of Directors Honorarium No

Do you intend to discuss an unapproved/investigative use of a commercial product/device? Yes No

If yes, please disclosure such references to the learner in the educational activity.

I have read and will adhere to the IHF/AHA/ACHE Policy on Conflict of Interest Disclosure. I will uphold

IHF/AHA/ACHE standards to insure that balance, independence, objectivity and scientific rigor are maintained in

the planning and presentation of this CE activity.

Name:_________________________________________ Date:___________________________

Please fax or email this document to Megan Angelini by June 22nd, 2015 at (312) 424-0023 or mangelini@ache.org

/s/Atefeh Samadi-niya May 21, 2015 Atefeh Samadi-niya